99dots

Abstract

Ensuring that patients adhere to prescribed medication remains an important challenge in global health. While technology has been utilized to monitor and improve adherence, solutions to date have been too costly for large-scale deployment in developing regions. This paper describes 99DOTS, a low-cost approach for tracking adherence using a combination of paper packaging and low-end mobile phones. Every day, patients reveal an unpredictable phone number behind the pills and send a free call to that number to indicate that drugs were dispensed and taken. Within five years of its inception, 99DOTS has become a standard of care for tuberculosis in India and has enrolled over 200,000 patients. We provide a holistic account of the project's evolution, including its iterative design, scaled implementation, and lessons learned along the way. We hope this account will serve as a useful case study for anyone seeking to establish and scale new low-cost technologies for a global audience.

Implementation of enhanced 99DOTS for TB treatment supervision in Uganda: An interrupted time series analysis

“…In the only randomized trial of 99DOTS to date, we showed that only 52% of people with TB were enrolled on 99DOTS, and 99DOTS-based treatment supervision did not improve treatment outcomes (2). Other implementation studies have found similarly low enrollment of people with TB on 99DOTS and have reported similar treatment outcomes between routine-and 99DOTS-based treatment supervision (1)(2)(3).…”

“…99DOTS is a low-cost DAT, whereby people with TB self-report medication dosing by calling toll-free phone numbers hidden underneath pills in blister packs (1,2). 99DOTS has been deployed in some Asian and African countries, including India (1,3), Uganda (2) and Kenya (4).…”

Technologies for Medication Adherence Monitoring and Technology Assessment Criteria: Narrative Review (Preprint)

“…Data directly related to publications, such as the country and publication year, were also gathered. Information regarding adherence monitoring technologies was extracted and organized into a table for further synthesis (Multimedia Appendix 2 [1][2][3][4][5][6][9][10][11][12][13][15][16][17][18]20,).…”

“…Some old versions of the MEMS often require manual download of the stored patient medication adherence data from the MEMS cap into the MEMS software through a small reader device [8][9][10]27,28]. Some newer versions of electronic pill bottle technologies, such as the GlowCap and AdhereTech devices, possess the ability to wirelessly transmit patient medication adherence data, providing opportunities to assess and monitor patient medication adherence in real time [1,15,18,[29][30][31]. Electronic pill bottle technologies are commonly reported to have advantages including their discrete design and small size [10,16,32,33], objective medication adherence monitoring ability [1,8,11,14,34,35], and acceptance among patients [1,30,31].…”

“…The advantages and limitations of the commonly used methods for measuring medication adherence have been described in the literature. For example, DOT allows for direct observation of patient medication-taking actions [16][17][18], but it is expensive to sustain and produces a constrictive time strain on both health care providers (HCPs) and patients' daily schedules [1,12,18,19]. As a common way to measure medication adherence, patient self-reporting respects patient autonomy but carries the potential risk of patient overestimation or underestimation of their adherence abilities [20][21][22].…”